Research Advances in Infectious Mononucleosis Caused by Epstein-Barr Virus

Infectious mononucleosis (IM), primarily caused by the Epstein-Barr virus (EBV), manifests as the classic triad of fever, pharyngitis, and cervical lymphadenopathy. Severe cases may involve organ damage, most commonly affecting the liver. Diagnosis relies on a combination of clinical presentation and laboratory parameters, with commonly used indicators including EBV-specific antibodies, EBV-DNA load, and the ratio of atypical lymphocytes. Treatment primarily involves symptomatic supportive care, with a cautious approach to the routine use of antiviral medications. In recent years, significant research in traditional Chinese medicine has been conducted in China, showing promising advancements. This article provides a comprehensive review of EBV-induced infectious mononucleosis, offering insights for clinical diagnosis and treatment.

A Case of Infectious Mononucleosis Induced Jaundice Complicated by Possible Drug Induced Liver Injury (DILI)

In this case, a young female presented with non-specific features such as fever, sore throat, headache and fatigue. She went on to develop epigastric pain, darkening of urine and jaundice, with no resolution of prior symptoms. Physical and Laboratory tests confirmed the primary diagnosis of infectious mononucleosis, however, prior history of treatment with multiple drugs led to a diagnosis of DILI as a complication. Appropriate treatment with I.V. antibiotics, hepatoprotective agents, steroids as well as discontinuation of all potential hepatotoxic agents showed significant improvement in patients’ symptoms and overall condition.

Diagnosis of Infectious Mononucleosis by Combined Detection of Atypical Lymphocytes and Transaminase

In order to explore the value of combined detection of atypical lymphocytes （ATL） and transaminase （alanine aminotransferase, ALT＇ asparate aminotransferase, AST） in the diagnosis of infectious mononucleosis （IM）, The data of blood routine and liver function were collected from 54 IM patients, 34 acute hepatitis （AH） patients, 44 upper respiratory infection （URI） patients in Union Hospital during March 2002 to March 2005. Same data were also collected from 40 healthy children as normal control. These data were analyzed retrospectively. Both proportion of atypical lymphocytes and enzyme activity of transaminase were elevated simultaneously （ALT〉40 IU/L, AST〉45 IU/L） in 57.4% （31/54） IM patients. There was significant difference （P〈0.01） between IM group and the other groups. Combined detection of atypical lymphocytes and transaminase can be regarded as a diagnostic marker of infectious mononucleosis.

Recurrence of infectious mononucleosis in adults after remission for 3 years:A case report

BACKGROUND Infectious mononucleosis(IM)is a disease caused by Epstein–Barr virus(EBV).EBV infection is common in children;however,it can cause IM in adults.Studies on recurrence of IM in adults after remission are limited.CASE SUMMARY We report a 28-year-old man who presented with IM-like symptoms with mild liver damage after initial remission of IM for 3 years.He was first diagnosed with IM and treated in 2015.Follow-up tests in 2016 and 2017 did not show any abnormalities.In November 2018,he presented with swelling of the tonsils.He was misdiagnosed with acute suppurative tonsillitis and treated for 5 d.No signs of improvement were observed.He was readmitted with recurrent fever,pharyngalgia,fatigue,and systemic muscle pain.Examinations revealed enlargement of the tonsils and cervical lymph nodes.Blood tests revealed elevated transaminase levels.Anti-EBV test was positive,indicating virus reactivation.IM recurrence was confirmed on the basis of laboratory tests and clinical manifestations.He was treated with antiviral,anti-infective,and hepatoprotective drugs and vitamin supplements.His condition improved and no abnormalities were observed during follow-up.CONCLUSION Recurrence of IM after remission is possible in adults;therefore,long-term followup and monitoring are essential.

Expression and clinical significance of miRNA-146a and IRF-3 in children with infectious mononucleosis

Objective:To investigate the expression levels of interferon regulatory factor 3(IRF-3)and miRNA146a in peripheral blood of children with infectious mononucleosis and the effect of miRNA146a on IRF-3 expression.Methods:In an in vivo experiment,the expression levels of IRF-3 and miRNA146a in peripheral blood of 45 children with infectious mononucleosis and 34 healthy controls were detected by real-time PCR.The in vitro experiment was performed to examine the effect of miRNA146a on IRF-3 expression levels by transfecting miRNA146a mimics and their inhibitors.Results:There was significant difference in IRF-3 gene expression in peripheral blood between healthy controls and children with infectious mononucleosis(t=30.340,P<0.001)while miRNA146a expression was significantly increased compared with healthy controls(t=34.659,P<0.001),and there was a negative correlation between the two groups(r=-0.960,P<0.05).In HeLa cells,transfection with miRNA146a mimics significantly decreased the expression of IRF-3 mRNA(t=8.270,P<0.001)and protein(t=46.170,P<0.001),while miRNA146a inhibitor significantly up-regulated the expression of IRF-3 mRNA(t=8.582,P<0.001)and protein(t=25.891,P<0.001).Conclusion:miRNA146a may be involved in the down-regulation of IRF-3 gene expression by Epstein-Barr virus in children with infectious mononucleosis and then involved in the pathogenesis of infectious mononucleosis.

A Case of Infectious Mononucleosis Complicated by Severe Thrombocytopenia and Hyperuricemia

Infectious mononucleosis (IM) by Epstein-Barr virus is usually a benign, self-limiting disease. Mild to moderate immune thrombocytopenia in the setting of IM is very common and appears in approximately half of these patients, however it rarely presents in severe form and troublesome haemorrhage is even rarer. Rapid spontaneous resolution is possible, with the role of steroids being controversial. Furthermore, elevation of the levels of uric acid because of immune thrombocytopenia is observed in high frequency;however this finding is usually not mentioned. It is attributed to a transient increase in purine turnover, it appears more often in men (with its peak within the first 2 weeks of IM) and it is treated with intravenous fluids and bicarbonates. The present case report describes the case of a young female patient who develops severe thrombocytopenia and intense hyperuricemia following an Epstein-Barr infection. No severe bleeding appeared, levels of uric acid normalised within the first two weeks of treatment and platelet levels rise back to normal within a month under corticosteroid therapy.

Epidemiological characteristics and disease burden of infectious mononucleosis in hospitalized children in China:A nationwide retrospective study

Epstein-Barr virus(EBV)is very common,with the infection rate in adults over 90%worldwide.Infectious mononucleosis(IM)is caused by primary infection with EBV.Most IM patients are generally considered to have a favorable prognosis,but a few patients will also develop complications.Children with severe symptoms will require hospitalization.However,the disease burden of children hospitalized with IM in China has been rarely described.In this study,we included the Face sheets of discharge medical records from 27 member children's hospitals of Futang Research Center of Pediatric Development from Jan 1st,2016 to Dec 31st,2020,and medical information such as gender,age,region,time of admission,length of stay and expenditure were extracted.There were 24,120 IM cases,which accounted for 0.42%(24,120/5,693,262)of all hospitalized cases during this period.The ratio of male to female was 1.48:1.Hospitalization for IM in the 4-6 years age group was the highest among inpatients of all age groups.Case numbers increased year by year between 2016 and 2020,and the monthly hospitalization was generally high from Jul to Sep but reduced from Jan to Feb per year.Bronchitis/pneumonia and hepatic dysfunction were two common complications in hospitalized IM patients.The median length of stay was 8 days,and the median cost of hospitalization was 970.59 US dollars.This study will help understand the epidemiological characteristics and disease burden of hospitalized children with IM in China.

Effect of Compound Glycyrrhizin Injection on Liver Function and Cellular Immunity of Children with Infectious Mononucleosis Complicated Liver Impairment

Objective： To investigate the effects of Compound Glycyrrhizin Injection （CGI） on liver function and cellular immunity of children with infectious mononucleosis complicated liver impairment （IM-LI） and to explore its clinical therapeutic effect. Methods： Forty-two patients with IM-LI were randomly assigned, according to the randomizing number table, to two groups, 20 in the control group and 22 in the treated group. All the patients were treated with conventional treatment, but to those in the treated group, CGI was given additionally once a day, at the dosage of 10 ml for children aged below 2 years, 20 ml for 2-4 years old, 30 ml for 5-7 years old and 40 ml for 8- 12 years old, in 100-200 ml of 5% glucose solution by intravenous dripping. The treatment lasted for 2 weeks. T lymphocyte subsets and serum levels of alanine transaminase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TBil） were detected before and after treatment. Besides, a normal control group consisting of 20 healthy children was also set up. Results： Baseline of the percentage of CD3^＋ , CD8^＋ lymphocyte and serum levels of ALT, AST, TBiL in the children with IM-LI were markedly higher, while the percentage of CD 4^＋ lymphocyte and the CD4^＋/CD8^＋ ratio was markedly lower in IM-LI children as compared with the corresponding indices in the healthy children （ P〈0.01 ）. These indices were improved after treatment in both groups of patients, but the improvement in the treated group was better than that in the control group （P〈0.01）. Conclusion： Cellular immunity dysfunction often occurs in patients with IM-LI, and CGI treatment can not only obviously promote the recovery of liver function, but also regulate the immune function in organism.

Clinical characteristics and effectiveness of antiviral agents in hospitalized children with infectious mononucleosis in China:A multicenter retrospective study

Importance:The clinical characteristics of infectious mononucleosis(IM)in Chinese children have not been evaluated in multicenter studies,and the effectiveness of antiviral treatment are controversial.Objective:To investigate the clinical characteristics of Chinese children with IM and current status of antiviral therapy for affected patients.Methods:Hospitalized patients with IM were enrolled between 2018 and 2020 in five children’s hospitals in China.The clinical characteristics were compared among four age groups:<3 years,3-<6 years,6-<10 years,and≥10 years.The clinical characteristics of IM and effectiveness of antiviral therapy were compared among patients receiving acyclovir(ACV),ganciclovir(GCV),and no antiviral therapy(i.e.,non-antiviral group).Results:In total,499 patients were analyzed;most patients were 3-<6 years of age.The most common symptoms and signs included fever(100%),lymphadenopathy(98.6%),pharyngitis(86.4%),eyelid edema(76.8%),and snoring(72.9%).There were significant differences in rash,hepatomegaly,and liver dysfunction among the four age groups.Patients aged<3 years had a lower incidence of liver dysfunction and a higher incidence of rash.Among the 499 patients,50.1%were treated with GCV,26.3%were treated with ACV,and 23.6%received no antiviral therapy.Compared with the non-antiviral group,patients in the ACV and GCV groups had longer durations of fever(P<0.001).There were no significant differences in the incidences of complications among the three treatment groups.Interpretation:The incidence of IM in Chinese children peaked at 3-<6 years of age.Clinical features of IM varied according to age.Patients receiving antiviral therapy exhibited more serious clinical manifestations than did patients without antiviral therapy.The effectiveness of antiviral therapy for IM requires further analysis.

Clinically Controlled Study on Children's Infectious Mononucleosis Treated by Chinese Medicine

Objective： To evaluate the clinical efficacy and safety of Chinese drugs for the treatment of children＇s infectious mononucleosis （CIM）. Methods： Sixty CIM patients were assigned into the treated group and the control group, patients in the treated group were administered with Chinese herbal decoction, and those in the control group were treated with intravenous dripping of ganciclovir 10 mg/kg per day, for a treatment course of 14 days. Results： The total effective rate was 96.0% in the treated group and 97.1% in the control group, showing insignificant difference between groups. The efficacy in the treated group was superior to that in the control group on the fever clearance time （3.0 ± 1.5 days vs 4.9 ± 3.9 days ） and the disappearance time of cervical lymph node swelling （0.8 ± 1.0 score vs 1.5 ± 1.2 score）, showing statistical significance （all P〈0.05）. T-cell subsets were markedly improved in both groups after treatment. Adverse reaction occurred in four cases of the control group. Conclusion： Using Chinese herbs for clearing heat, removing toxin, activating blood circulation, and dissolving stasis is effective and safe for the treatment of CIM. It can effectively improve the clinical symptoms and shows a certain effect on immune regulation.

Dapsone-induced infectious mononucleosis-like syndrome in a patient with pemphigus vulgaris

Dapsone syndrome is characterized by high fever, skin rash, methemoglobinemia, liver toxicity, and generalized lymphadenopathy.The incidence of me dapsone syndrome is increasing with the extensive application of dapsone. However it is rarely reported in pemphigus. We present a case of ＂infectious mononucleosis-like＂ dapsone syndrome in a patient with pemphigus vulgaris. The syndrome appeared when he was being treated methylprednisolone, which was commonly used as a treatment for dapsone syndrome.

The sero-epidemiology of infectious mononucleosis in Neyshabur,Northeast Iran during 2010-2014

Objective:To detect infectious mononucleosis(IM)prevalence in Neyshabur,Northeast Iran during 2010-2014.Methods:This cross-sectional descriptive epidemiological survey was performed to reveal the prevalence of IM in Neyshabur between 2010 and 2014.A total of 114 individuals were studied.Briefly,individuals with positive test for specific immunoglobulin G and immunoglobulin M in the agglutination test were determined as positive cases.Results:The overall prevalence of IM was 14%.Mean±SD of age for IM test was 18.96±15.79.The age groups of 0-10 and 21-30 were the most positive cases in this period.In addition,31-40 and over 50 years were not positive cases.Male individuals were significantly more positive and likewise,it was observed that there were significantly higher positive cases of IM in spring and summer.Conclusions:Among the five years of this study,it was a decreasing status from 2010(23.1%)to 2014(9.1%),though a slight fluctuation had occurred.The prevalence of IM was low in Neyshabur City.Moreover,children and male individuals had relatively higher prevalence of the disease.Furthermore,it was observed a higher rate of IM in spring and summer.

Livedo Reticularis in a Patient with EBV Mononucleosis

A 23-year-old woman with serologically confirmed EBV mononucleosis presented with fever, exudative pharyngitis, periorbital and lid edema, cervical lymphadenopathy, and splenomegaly. Two weeks after the onset of symptoms she developed a generalized symmetrical reticular eruption of unbroken hexagons characteristic of livedo reticularis that resolved over several weeks as her condition improved. To our knowledge, this is the first reported case of livedo reticularis to occur in a patient with EBV mononucleosis.

Epstein-Barr virus:Silent companion or causative agent of chronic liver disease?

The Epstein-Barr virus(EBV)has an important and multifaceted role in liver pathology.As a member of the herpes virus family,EBV establishes a persistent infection in more than 90%of adults.Besides acute hepatitis during primary infection,many clinical syndromes of interest for the hepatologist are associated with EBV infection.The role of EBV in the evolution of chronic hepatitis from hepatotropic viruses is considered.Chronic EBVassociated hepatitis is suspected in immunocompetent adults with compatible serology,suggestive histology and detection of the viral genome in the liver and/or increase of specific circulating cytotoxic T-lymphocytes.EBV is the main cause of post-transplant lymphoproliferative disorders which occur in up to 30%of cases.EBV-driven lymphoproliferative diseases are also recognized in non-immunocompromised patients and liver is involved in up to a third of the cases.Directly implicated in the pathogenesis of different tumors,EBV has a disputable role in hepatocellular carcinoma carcinogenesis.Further research is required in order to establish or reject the role of EBV in human liver cancer.This paper attempts to discuss the range of EBV-associated chronic liver diseases in immunocompetent patients,from mild,self-limiting mononuclear hepatitis to liver cancer.

Celiac sprue-a cryptic disease:A case report

BACKGROUND Celiac sprue,or celiac disease,is a relatively common disease whereby many are unaware that they have it.It often manifests with symptoms outside of the digestive system.Many health care providers are unaware of the wide variety of symptoms of celiac disease as well as diseases that are associated with it,often delaying diagnosis and treatment.CASE SUMMARY The following case indicates an otherwise healthy 20-year-old female who presents with a variety of symptoms and is ultimately diagnosed with shingles,infectious mononucleosis,and celiac disease CONCLUSION Although it is known that risk-factors are genetic as well as environmental,much more research is needed to better understand the relationship of potential causes.In addition,continuing education is needed in health care so that more practitioners better understand celiac disease.

Chronic Active Epstein–Barr Virus Infection

Chronic active Epstein-Barr virus(CAEBV)infection is a systemic Epstein–Barr virus(EBV)positive lymphoprolifetative disease characterized by fever,lymphadenopathy,splenomegaly,unusual pattern of antiEBV antibodies,and/or increased EBV genomes in affected tissues.Most cases are from Asia.So far,there is hardly any adult case reported from mainland of China.We herein presented a 33-year-old man with fever,facial erythema and rash,lymphadenopathy,lower limbs weakness,splenomegaly and liver lesion.EBV VCA,EA and EBNA were all positive.EBV DNA could be found in serum and PBMC.In situ hybridization of EBV encoded RNA in skin and liver biopsy was positive.Viral load in serum decreased under interferon alpha therapy.To our knowledge,it’s the first adult case reported from mainland of China.